Your thoughts on this treatment (Cytoxan, Adrimyacin)

Youandwhosearmy

- Ductal Invasive pure mucinous carcinoma, right breast, 7x5 cm

- 57 years old woman, around 60 kg, good health otherwise... 

- Scarff-Bloom-Richardson score of 4, grade 1 (of 3)

-Estrogen positive (could benefit from anti-estrogen hormonal therapy)

-ER/PR/HER2: 2 positives, 1 negative... I'm sorry but I can't remember which ones.

-Possible "small" (according to PET-CT) invasion of the axilary limph nodes, TBD after mastectomy (oncologist says it's irrelevant to do any tests at this point right before treatment).

-PET-CT scan shows goiter with maximum SUV of 6.1, but very unikely to be a metastasis, according to the oncologist and pathologist. No metastasis otherwise.

-Stage 3A or 3B

Treatment plan is as follows:

3 rounds of chemotherapy (1 every 21 days), each one consisting of: 

-80 mg of Adriamycin (doroxubicin) 

-1 gram of Cytoxan (cyclophosphamide)

If tumor is small enough after treatment, a mastectomy woud follow. Treatment TDB after mastectomy results.

Any info (prognosis, statistics, previous experiences, side effects, etc.) on this treatment would be greatly appreciated! Thanks!

Panchoandlefty

Well, I don't know the specific doses included in chemo. I think it is usually based on weight. 

My guess is that she is Estrogen and Progestrone positive, Her-2 neg. 

What I do know is that the protocol you write about isn't the typical 3rd generation "Standard of Care." Usually, that would be 4 cycles of Adriamycin + Cytoxan every 2 weeks then Taxol every 2 weeks for 4 cycles. The older protocol was administered every 3 weeks, but the "dose dense" routine has been the norm for a couple of years. Sometimes Taxol is given once a week for 12 weeks instead of every 2 weeks. Mostly, that is with Her-2+ patients.  

I'd ask your oncologist why this protocol is preferred over the Standard of Care. Doing chemo first is called neoadjuvant chemotherapy. It is pretty common with larger tumors. The nice thing about it is you can actually watch the tumor shrink so you know it is working.

I did dose dense ACT... I was on the positive end of the side-effect spectrum. I worked out throughout chemo. On the day of infusion through day 4, I walked 2-3 miles. After that I was at the gym. Anti-nausea meds are wonderful these days. I was on Emend and Zofran. Never threw up. I did treatment on Thursday, was down for the weekend (except my walks), then pretty much OK by Monday. Fine by Tuesday, though not 100%. I'd get pretty tired/easily overwhelmed in the afternoons. I could always take care of myself, but appreciated whatever help I could get with the kids, family dinner, etc. 

I went to all treatments alone and picked up carpool afterwards. The yucky stuff took about 24 hours to hit. I had 3 yr old twins and a 6 yr old so "taking it easy" wasn't really an option. Probably, for me, that was a good thing.

One never knows how they'll feel until treatment begins. I had an easier run than most, but I think almost everyone will say however bad their experience, it was better than they expected. I think a lot depends on one's health, support system, and emotional well-being going into the process.

So far as prognosis... Stage III is serious stuff. Until they can do a surgical biopsy of the nodes, you really won't know the stage. MRIs and such aren't a great measure. Lymphatic involvement is significant.

Recurrence rates are high, but there are plenty of positive stories from stage III women who complete treatment, move past cancer, and die in their beds of old age. The mathmatical odds can be discouraging, but statistics reflect groups, not individuals. New treatments continue to bolster survival rates. Keep moving forward.

Stephanie 

Springtime

Like Stephanie above, I am getting 4ACs followed by 4 Taxols, all every 2 weeks. I've only had my first 2 AC's so far, mine is also before the mastectomy, but no nodes (they did a sentinel node biopsy as part of my staging tests along with CT, bone scan, etc).  I have never heard of 3 ACs (every three weeks) and that's it. never. hmm.

I too can say that so far, it is not as bad as I expected. I am still wroking (I work at home for  large company) and I am pretty much keeping up. My treatments are on Monday. Monday is not a great day for me, and the rest of that week I am not at my best. I found that if the nurse administered the AC slowly (rather than quickly during my first one) it was much easier on me. By the next Monday, I feel generally back to normal. The Emend (anti nausea) is awesome, I never throw up, sometimes feel a bit green, but I don't take any of the other anti nausea meds as them just make me feel tired and "drugged". I just the Emend days 1-3, the Dex (steroid) days 1-4 and Atavan to sleep at night on the same days I take the steroids (I find they buzz me up). When I feel a bit "green" I eat a bit of something. Tummy does not like to be empty first week, so I pace myself, any little something in the tummy works. 

The first few weeks after diagnosis are really hard. I found going through all the staging tests and not knowing was really the hardest on me. I found that once I started chemotherapy treatments, I was doing something, and felt a bit less anxious. I was scared for my first treatment, I thought I would "blow up" or something, but the second one was not as scary. 

I agree with Stephanie, keep moving ahead. Other women have done this. You can too.